Background Information for Medical Placements/Electives Abroad
The following text tries to provide background information about the medical systems in the different countries and tries to classify the medical institutions where we arrange placements within these system, in order to assist you finding the right option for your elective, final year rotation, internship or medical volunteer work.
Contact us and we are happy to assist you!
Tanzania
In Tanzania we can arrange placements for medical elective students, interns of nursing and therapies, pre-medical students and professional volunteers into a wide range of public and private medical institutions.
The public health system in Tanzania has a referral system: Someone who needs treatment usually first attends a small medical dispensary. Dispensaries are in all parts of towns and cities such as Moshi, Dar-es-Salaam etc. and in many villages, treating all common things such as small injuries, infectious diseases, Malaria, diabetes, high blood pressure etc.; also they often do deliveries.
There are public and private dispensaries. The public dispensaries are usually very simple in terms of equipment and facilities. In villages and outskirts of cities, they often they don't even stock elementary medicines and can only offer very basic medical services. The private dispensaries are often very similar to the public ones, but sometimes they are of higher standard in terms of facilities, equipment and services offered.
Any state-approved nurse can open a private dispensary. Dispensaries are usually run by a nurse or by a "medical officer" who is something between a nurse and a physician; some might employ further nurses, medical officers and laboratory technicians. The nurses and medical officers at the dispensaries can prescribe and use all standard medicines. There is typically no real physician who has studied medicine for 4-5 years. If it is a requirement from the university that for an elective/medical internship a proper physician is needed as a supervisor, this is not possible at a dispensary. For volunteers who have professional skills such as nurses, therapists and physicians, dispensaries are very good places to volunteer at, as through their skills they can support the local staff a lot and work like a regular team member, including stitching wounds and treating patients, assisting with deliveries, even without supervision if they are sufficiently qualified. Also internships for pre-medical students are possible at dispensaries.
Examples for such dispensaries where we can arrange placements are Hosiana Clinic and Dorcas Laboratory in Moshi. In Zanzibar, placements at dispensaries are usually not possible, as the Health Ministry doesn't allow so for foreigners.
The number of patients at dispensaries might fluctuate a lot during the year. Usually during the rainy season (March to June and November) there are more infectious diseases and more cases of malaria.
If a patient needs something of higher specialization that cannot be done at a dispensary or which is beyond the competence of the nurse or medical officer, he or she is referred to a Regional Hospital such as Mawenzi Regional Hospital in Moshi.
Patients however can also go directly to a Regional Hospital. Particularly people living in the cities near a regional hospital often prefer to go directly to the hospital and skip the dispensary, as they expect better service at the hospital.
Regional hospitals usually have many, many patients and elective students and professional volunteers have the chance to see many cases, often in very late stages of diseases.
Regional hospitals are used by patients who are of average income, or poorer parts of the population, if they feel so sick that they don't have any other option. A lot of time often passes between having been at a dispensary and going to the Regional Hospital, during which the patient’s medical condition can get worse, because poor patients usually have to collect the money to cover costs for the treatment from relatives, neighbours, churches and other sources, which can take days to weeks. The costs for a consultation by a doctor at a regional hospital might be around 5,000-7,000 TSH (around 2.50-3 €/3.30-4 USD), plus costs for medicines which might be typically between 2,000 and 10,000 TSH (1-5 €/1.30-6.50 USD). Major surgery and having to stay as an inpatient might cost around 100,000-200,000 TSH (50-100 €/65-130 USD). An average monthly household income is around 90 €/120 USD (for a whole family), but around 65% of Tanzanian households only have 30 €/40 USD or less per month. Patients usually don't seek medical treatment for minor reasons; nobody goes for prevention.
Regional Hospitals have various common departments; you can read the list of available departments at Mawenzi Regional Hospital and other hospitals on our website. Work at the regional hospitals is often tough, as doctors have to treat many patients who have serious medical conditions within a very short time. Therefore they often don't have a lot of time to give lengthy explanations to elective students. Students usually assist the doctors and nurses with tasks such as stitching wounds, changing dressings, assisting during the consultation, attending doctors during the ward round etc, always under supervision. There is qualified staff who can sign and stamp forms about electives as required by universities.
Above the level of the Regional Hospitals there are very large and higher specialized hospitals which are called "Referral Hospital" such as Muhimbili National Hospital in Dar-es-Salaam and Bugando Medical Centre in Mwanza, which are often attached to medical universities. Patients cannot go directly to a Referral Hospital, but they need a reference from a regional hospital first. Mnazi Mmoja Hospital in Zanzibar is a Referral Hospital where patients can go directly, but this is because on the small island of Zanzibar there are no Regional Hospitals.
The standard of the departments/wards within one hospital can vary very much (both at Regional and Referral Hospitals), some departments might have good equipment and might be in good condition, typically resulting from money provided by foreign development programs. For instance the HIV/AIDS and physiotherapy wards at Mnazi Mmoja Hospital Zanzibar are very modern, but the pediatric ward is very poor and needs renovation. At Mawenzi Regional Hospital they have recently renovated the main surgery theatre.
As the public medical system in Tanzania is not very satisfying, there are many private healthcare facilities.
Some are (compared to the public hospitals) expensive and provide better standard (either/or or all in terms of facilities, equipment, or time that a doctor provides to patients), attracting patients who have more money. SIIMA Hospital in Moshi is one of these. Others are funded by charitable organizations or churches (e.g. St. Joseph Hospital). They are of higher price level than the public hospitals to the general public, but might offer free services to particularly poor people in need (which are financed by the money paid by the "richer" patients). In terms of facilities and equipment they are usually better than most public hospitals (unless the public ones have a particular department or ward which got a lot of foreign money). Usually there are fewer patients at the private hospitals and therefore doctors/nurses have more time to give explanations to foreign students/interns.
When it comes to doctors, the same doctors work at the public and at the private hospitals. As the salaries are low, they need income from several employers and therefore work at 2-3 hospitals (usually one public and 1-2 private) at the same time.
The Regional Hospitals and Referral Hospitals of Tanzania are usually accredited by all international medical universities for elective placements. Final year medical rotations are possible at Muhumbili Hospital in Dar-es-Salaam and Bugando Medical Centre in Mwanza, which are teaching hospitals of medical universities.
Ghana
The public health care system of Ghana has three reference levels.
The smallest facilities that provide medical first aid (Tertiary Level) are the so-called CHPS (Community Health Compounds), health centers and small hospitals. These facilities perform only outpatient treatment and are usually run by nurses. Each facility is aimed at a population density of about 20,000 people.
At Secondary Level are the district hospitals, which are aimed at a population density of about 100,000-200,000 people. The bed capacity is usually not more than 100 beds.
These have at least one operating theater and a laboratory and usually offer better medical care than institutions on the tertiary level.
The highest level (primary level) are Metropolitan Hospital, Regional Hospital and Municipal Hospital. They are located in cities whose population exceeds 200,000 people and have a correspondingly larger bed capacity. In addition to several operating rooms and relatively good technical equipment, there are general practitioners and specialists in various disciplines to treat patients.
The primary level hospitals and many private hospitals such as the University Hospital in Cape Coast are of high standards in terms of facilities, management and expertise. Secondary and Tertiary institutions are often underfunded.
Morocco
In Morocco we arrange elective placements at private clinics which are of higher standard, often coming close to Western/European standard in terms of facilities, equipment and professional level of the staff. We currently don’t work with public hospitals, as they are very bureaucratic.
The private hospitals are expensive for many local people, but they often collect funds for people who are in need, allowing them to provide cheap or free treatments.
At these hospitals, medical students/interns should have no problem to get accreditation for elective placements by international medical universities or nursing schools.
Professional volunteers (nurses, therapists and physicians) can volunteer at church-run charitable dispensaries such as the one by the Franciscan Brothers of the White Cross in Tangier, which are typically managed by a nurse, providing free basic medical services to the poorest parts of population. As there is no medical supervision, elective placements are not possible at such dispensaries.
India
In India, we work with private hospitals of higher standard, for the same reasons as in Morocco. The standard of equipment, facilities and qualification of the doctors are comparable to Europe/North America/Australia. They offer a wide range of departments with high specialization.
At these hospitals, medical students/interns shouldn't have any problems to get accreditation for elective placements by international medical universities or nursing schools.
Professional volunteers (nurses, therapists and physicians) can volunteer at charitable hospitals which are funded by charitable organizations, but also at medical outreach programs run by several NGOs in slum areas.
Nicaragua
In Nicaragua we can offer placements at the public hospital HEODRA and private hospial AMOCSA in León.
The standard of the public HEODRA hospital is low in terms of equipment and facilities, comparable to Tanzania. Also the situations that many patients have difficulties in raising the funds needed for their medical treatment, that they often only seek for medical services at a late stage of their disease, and the working conditions at the hospitals are very similar to as described in the text about Tanzania. Professional volunteers are very much needed at the public hospitals.
HEODRA as a large teaching hospital of León medical university should be fully accredited by all foreign medical universities and nursing schools for electives, internships and final year rotations.
The standard of the AMOCSA private hospital in terms of facilities and equipment is better than HEODRA. There are less patients and fees are higher. The doctors have more time for each patient. HEODRA is bigger and has a larger variety of highly specified departments; students will have the chance to see more patients than with AMOCSA.
Also, the same doctors work at HEODRA and AMOCSA. To make a living, they additionally even work at further private hospitals or run their own consultancies.
Bolivia
The standard at the public hospitals of Bolivia can fluctuate a lot. While some private hospitals are chronically underfunded, others such as the hospitals of the VIEDMA Health Park where we arrange electives, internship and volunteering options often can offer a standard that comes close to the one of European/North American/Australian hospitals. They have a wide variety of specialization and departments.
A problem that regularly recurs is that the funds for the salaries of staff and to pay for medicines is not provided, resulting in shortages of medical services.
Similar to the what has been described before about Tanzania and Nicaragua, many people cannot afford the treatments at the public hospitals. They only attend medical institutions when their disease is in an advanced stage and in absolute emergencies.
Arco Iris is a charitable private hospital in La Paz of very high standard. Relatively rich people pay high fees for their treatment which is of one of the highest standards available in the country, and the money is used to provide free treatment to poor people, particularly street children and children from the poorest classes of society. 40% are paying patients and 60% are not paying.
Volunteer placements for healthcare professionals and elective placements/internships for students are possible at all of these hospitals. The hospitals of the VIEDMA Health Park in Cochabamba as large teaching hospitals of medical universities should be fully accredited by all foreign medical universities and nursing schools for electives, internships and final year rotations.
Mongolia
The medical system of Mongolia is of high standards. There is medical faculty at the University of Ulaanbaatar, also many doctors have studied in Russia or China or even have higher qualifications. There is no teaching hospital at the Mongolia university, so final year rotations are probably not possible. Mongolian medical students do electives with you in various medical institutions.
The health care system in Mongolia is organized as a tripartite reference system where patients first seek a "Family Health Center", which is a general physician's office. From there, the patient, if necessary, is referred to the district health centers, the second stage of the reference system, where there are more general medical facilities with more medical equipment (e.g. X-ray, ultrasound, endoscopy) and where general surgical procedures are performed. In such district health centers, about 12 physicians and 60 nurses are available to patients. Both family health centers and district health centers only treat outpatients. In these facilities, electives and internships are available from the 1st year.
The third stage in the Mongolian reference system are specialized clinics. There are no major hospitals in Mongolia, which have many specialisations, but instead clinics that are each limited to a field of study. These include hospitalization. For an elective or a nursing internship in these clinics, you should be at least in the 3rd year of study.